Journal of Clinical and Aesthetic Dermatology

JUN 2017

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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47 JCAD journal of clinical and aesthetic dermatology June 2017 • Volume 10 • number 6 R E v I E W of elderly patients are affected by xerosis. 36 ceramides also play a role in the differentiation of keratinocytes and regulation of cell signaling. 3 7 DerMend contains a proprietary blend of specifically targeted ceramides (ceramide nP, ceramide ns, ceramide eOs, ceramide eOP, and ceramide aP), and several studies have demonstrated the beneficial effects of this combination of ceramides in mature skin. Using an in vitro model, the effects of the ceramides phytosphingosine, sphingosine, sphinganine and their hexanoyl-, stearoyl- and salicyl-derivatives were assessed using human keratinocytes. 37 Most of these substances were found to be potent promoters of keratinocyte differentiation. Improvements in skin barrier function have been demonstrated following the topical application of physiologic amounts of the ceramides sphingosine, phytosphingosine, esterified fatty acids, omega hydroxy fatty acids, normal fatty acids, and alpha-hydroxy fatty acid in human volunteers. 38 a controlled clinical trial assessed the beneficial effects of a ceramide 3-containing emollient using an experimental skin barrier dysfunction model in healthy volunteers. 39 skin barrier dysfunction was caused by tape stripping, which resulted in erythema and increased transepidermal water loss associated with up-regulation of cycling cells, involucrin, and expression of cytokeratin-16. half the injured areas were treated once daily with the test product for five days. On Day 4, the ceramide-containing emollient significantly decreased erythema, transepidermal water loss, and cycling cells vs. the untreated site. Niacinamide. niacinamide (or niacin) is a form of vitamin B3 with antioxidant properties that help improve skin appearance. It regulates poly-aDP ribose- polymerase 1, an enzyme with important roles in Dna repair and the expression of inflammatory cytokines. 40 niacinamide has been shown to increase the beneficial effects of moisturizers for treating xerosis by improving the integrity of the stratum corneum 41 and increasing corneal hydration. 42–44 the application of niacinamide can also improve the appearance of fine lines and wrinkles, 45,46 hyperpigmentation spots, texture, red blotchiness, and sallowness. 46 In one randomized clinical trial, female subjects (n=50) with signs of facial photoaging including fine lines and wrinkles, poor texture, and hyperpigmented spots applied 5% niacinamide to half of the face and its vehicle control to the other half twice daily for 12 weeks. 47 Facial images and instrumental measures were obtained at baseline and at four-week intervals. significant improvements in skin appearance included reduction in fine lines and wrinkles, hyperpigmented spots, red blotchiness, sallowness, and skin elasticity. Interestingly, oral nicotinamide Fi g u r e 1 . T h e ap p e aran c e o f ac t i n i c p u r p u ra ( l e f t ) i s g re a t l y i m p ro v e d af t e r t re a t m e n t f o r 5 6 d a y s ( r i g h t ) .

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